The goal of this project is to gain experience and expertise in health protection research and identify opportunities for primary and secondary prevention of terrorist and disaster-related behavioral health disturbances by assessing the effects of the terrorist attacks of 2001 on the health of New York City's communities. The applicant aims to determine whether there was an increase in emergency department or outpatient medical utilization among vulnerable populations consistent with stress-related visits and associated with an adverse affect on the overall health of the community. The research and training program involves (1) documenting past patterns of medical care utilization in post disaster periods in developed nations (2) conducting an epidemiologic study of serial demographic, clinical, diagnostic and socio-economic variables associated with outpatient and emergency department use and creating a geographic information system to compare observed vs. expected population bases rates (3) testing the hypothesis that the post-impact period is an independent risk factor for the occurrence of anxiety-related outpatient and emergency visits among vulnerable populations by utilizing epidemiologic surveillance-related statistical tools and calculating correlations and regression analyses, and; (4) examining evidence of spatial or temporal associations between the events of 2001 and deleterious effects on overall community health as indexed by public, medical, social and mental health indicators such as the occurrence of intimate partner violence. The project has implications for practitioners in responding to post-disaster behavioral health needs, public health agencies in establishing baselines for surveillance and planning for surge capacity demands, and emergency management policy makers in educating and mobilizing their communities.